Form Rp-1-Afr Catv - Catv Annual Financial Report Page 3
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10RP-1-AFR CATV (2/14) Page 3 of 10
Certification
I certify that I have examined this report and that all statements of fact contained
therein are true, complete, and correct to the best of my knowledge, information, and
belief and that nothing material has occurred that would require explanation that has
not been explained.
Signature
Title
Printed name of signer
Date signed
Officers’ salaries or owner’s withdrawals $
In accordance with instructions below, enter above for the reported period:
Corporation: wages for stockholders and officers as reported on company’s Income Statement
(i.e., W-2 wages adjusted for accrual basis)
Subchapter S corporation: wages for stockholders and officers as reported on company’s
Income Statement and any other stockholder distributions for working stockholders only
Sole proprietorship: withdrawals by working owner, in lieu of wages
Partnership: withdrawals by working partners only, in lieu of wages
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Parent category: Financial